Well, we could always try to do both :-(.
Asthma is something that causes me some concern. While an SHO in the UK, I
admitted a 15 year old girl, who I then turfed to another team. She died
with/of bilateral tension pneumothoraces, tensin pneumoperitoneum. Few years
later, as an accredited SR, I went to do a year of ICU in Auckland.
Revelation. They get 30 ICU admissions per year. Had had NO deaths, except
in patients wko had suffered pre hospital arrest. And, remember, NZ seems to
have the worst asthma in the world. As I say to juniors, in asthma you
cannot breathe. The nebulised particles rely on air movement to get them to
the bronchioles. No air movement, no effect. Asthma is the only condition
where the route of administration in the very sickest, is the one route
where absorption is not likely. So, give the drugs IV. It was a revelation.
The doses were boluses of 0.5 mg Salbutamol IV. My personal record was 50 mg
over about 10 mins. No, I have not made a mistake with the dose, or the the
timing. I hyave not had to ventilate a young asthmatic for ages.
Gets off soap box, and takes cover.......
Nick
Dr NJD Macartney MBBS FRCA
ICU, Chase Farm Hospital
Enfield
Middlesex EN2 8JL
-----Original Message-----
From: Danny McGeehan <[log in to unmask]>
To: Watson, David <[log in to unmask]>; Simon Carley
<[log in to unmask]>; Rowland Cottingham <[log in to unmask]>;
Nick Macartney <[log in to unmask]>; John Ryan <[log in to unmask]>; Harvey
Louzon <[log in to unmask]>; Ed Walker <[log in to unmask]>; Carlos
Perez Avila <[log in to unmask]>; Bill Hulse <[log in to unmask]>;
[log in to unmask] <[log in to unmask]>
Date: 28 September 1998 10:57
Subject: Asthma mortality
>Dear Colleagues
>I have just reviewed the reports from the Royal College of Surgeons and the
>British Orthopaedic Association recommending the setting up of 30 trauma
>centre type systems in the UK. If my memory serves me correct we have just
>over 2000 trauma deaths in the UK. With increased car ownership and
>traffic congestion it is likely that automobiles will be able to generate
>sufficient speed to inflict serious injury. After the effects of Mrs.
>Thatcher in the last decade the UK has very little heavy industry. Apart
>from a few serious incidents GSW's are fortunately relatively rare.
>Therefore major trauma in the UK is likely to diminish. If the concept is
>introduced the trauma surgeons are going to spend a lot of time twiddling
>their thumbs.
>However I understand that last year the deaths from asthma overtook those
>from trauma in the UK. This is an area that is not properly resourced.
>Should we not be concentrating a lot more in this area and perhaps
>diverting some of the resources from major trauma into this region
>Danny McGeehan MB FRCS FFAEM
>Consultant in A & E
>Stafford
>Deep in the Heart of Rural England
>E-mail [log in to unmask]
>Home +441782 712488
>Work +441785 257731 Ex 4567
>Fax +441785 230111
>
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